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When the Wisconsin Medicaid managed care program was expanded to include members who had traditionally opted out of the program, the HMOs that were going to serve these members had to optimize their member engagement strategies.

Independent Care Plan (iCare), one of the HMOs selected as a Medicaid plan, identified early member engagement after enrollment as a key to success for the program.

Telephonic and Community-Based Care Coordination Model: An Early Engagement Approach for Medicaid Managed Care outlines how iCare has structured its care coordination team, including both telephonic and boots on the ground staff to find, engage and assess Medicaid members.

In this 25-page resource, Lisa Holden, vice president of accountable care, iCare, shares the key elements of its care coordination model that has allowed it to achieve a 90 percent health risk assessment completion rate within 60 days of enrollment.

Ms. Holden covers the following topics in this report:

• The timing of iCare’s early engagement effort by its telephonic care coordinators and the goal for this initial contact;
• A 13-point protocol for care coordinators to locate hard-to-find Medicaid managed care members and details on how iCare holds the care coordinators accountable for this protocol;
• The role of health coaches within the community in helping to locate Medicaid managed care members and connecting them with needed social support services;
• How the care coordinators help Medicaid members overcome barriers to care;
• Seven rising risk/acuity identification tools;
• Readmission prevention initiatives for high-risk patients;
• Three programs aimed at reducing high emergency department utilization;
• Details on a Follow-to-Home program for members who are homeless;
• and much, much more.

Table of Contents

• Medicaid Member Engagement: A Telephonic Care Coordination Relationship-Building Strategy
  • Early Engagement After Enrollment
  • Difficult to Contact Resources List
  • Core Elements of the Care Coordination Model
  • Once Engaged
  • Overview of Care Coordination
  • Health Coaches
  • Social Health Determinants
  • Overcoming Barriers to Care
  • Rising Risk/Acuity Identification Tools
  • Readmission Prevention
  • High ED Utilization
  • Inpatient Reduction Components
  • Frequent Admitters
  • Inpatient Psychiatric Stays and Readmits
  • Primary Care Assignment
  • Follow to Home for Homeless
  • Ongoing Support
  • Wellness Clubs and Community Health Fairs
• Q&A: Ask the Expert
  • Potential Specialists To Add To Care Team
  • Staffing Requirements
  • Language To Avoid When Engaging Medicaid Members
  • Incentives for Engagement and Activation
  • Best Times of Day, Time of Month To Contact Medicaid Members
  • Assessing for Readmission Risk
  • Skill Sets and Background of Care Coordinators and Health Coaches
• Glossary
• For More Information
• About the Contributor

This report is part of the HIN Healthcare Case Studies series, which bundles inside details on innovative programs from leading-edge healthcare organizations on a range of topics — all aimed at achieving healthcare's Triple Aim of improving the patient experience of care, improving the health of populations and reducing the per capita cost of healthcare.

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